The diagnosis and management of massive pulmonary embolism

Miller, Graham

doi:10.1002/bjs.1800591025

Cited by 17 publications

(3 citation statements)

References 13 publications

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“…Furthermore, much of the observed morbidity and mortality correlated with the incidence of preoperative cardiopulmonary resuscitation (CPR) rather than procedure-specific complications. 53 54 55 56 In a recent scientific statement from the AHA, Goldberg and colleagues reported the in-hospital mortality rate following SE in modern studies to range from 2.3 to 13.2%, with mortality rate of only 2.9% in those who did not require preoperative CPR. 56 Thus, current techniques in surgical embolectomy in expert hands result in improved outcomes with high-risk PE.…”

Section: Surgical Management Of High-risk Pementioning

confidence: 99%

Advanced Treatment of Hemodynamically Unstable Acute Pulmonary Embolism and Clinical Follow-up

Fulton,

Bashir,

Weinberg

et al. 2023

Semin Thromb Hemost

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High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients. However, the most recent guidelines for the management of PE have reserved the use of these advanced therapies in scenarios where thrombolytic therapy plus anticoagulation are unsuccessful. This is due largely to the lack of prospective, randomized studies in this population. Stemming from this, the approach to treatment of these patients varies widely depending on institutional experience and resources. Furthermore, morbidity and mortality remain unacceptably high in this population, with estimated 30-day mortality of at least 30%. As such, development of a standardized approach to treatment of these patients is paramount to improving outcomes. Early and accurate risk stratification in conjunction with a multidisciplinary team approach in the form of a PE response team is crucial. With the advent of novel therapies for the treatment of acute PE, in addition to the growing availability of and familiarity with mechanical circulatory support systems, such a standardized approach may now be within reach.

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Section: Surgical Management Of High-risk Pementioning

confidence: 99%

Advanced Treatment of Hemodynamically Unstable Acute Pulmonary Embolism and Clinical Follow-up

Fulton,

Bashir,

Weinberg

et al. 2023

Semin Thromb Hemost

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“…В качестве основы для анализа исходов оперативного лечения и дооперационного статуса пациентов взяты базовые клинические и ангиографические характеристики тромбоэмболического поражения артериального легочного русла, с количественной оценкой по методу Миллера [11,13]. В дополнение к этому мы провели анализ сохраненного периферического кровотока на уровне сегментарных ветвей легочной артерии с оценкой наличия и развитости бронхиальной коллатеральной сети.…”

Section: результатыunclassified

“…Вестник рентгенологии и радиологии | Journal of Radiology and Nuclear Medicine | 2019 | Том 100 | №6 | 363-371 тирования в одной сегментарной артерии оценивается 1 баллом, а тромб главной ветви легочной артерии -суммой сегментарных артерий [10,11].…”

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Predicting the Success of Emergency Surgical Treatment of Acute Massive Pulmonary Embolism Based on the Results of Multislice Computed Tomography

Trofimova

Sukhova²

2020

Vestn. rentgenol. radiol.

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Objective – to assess the informativeness of multisclice computed tomography (MSCT) angiopulmonography in the assessment of peripheral blood flow and to determine the prognostic role of angiographic massiveness and volume of preserved peripheral blood flow as predictors of success of emergency surgical treatment of acute massive pulmonary embolism (PE). Material and methods. The article presents the results of 7-year work for the period from March 2012 to September 2019, which included a pilot retrospective stage (analysis of the results of 264 MSCT procedures with contrast enhancement for acute PE in patients aged 32 to 69 years for the period 2012–2013) and prognostic practical work (the second stage, analysis of the results of 974 MSCT procedures with contrast enhancement in patients aged 25 to 78 years for the period 2013–2019).Results. The obtained results and statistical dependences proved the influence of the saved volume of peripheral arterial pulmonary blood flow on the outcome of surgical treatment. The use of this indicator as an MSCT predictor reduced the hospital mortality rate from 7.2% to 3.5%. The analysis of the influence of the initial angiographic massiveness of PE on the outcome of surgical treatment has not been confirmed.Conclusion. According to the results of the study, we recommend the inclusion of segmental arterial pulmonary blood flow analysis by MSCT with contrast enhancement in the algorithm of preoperative examination of patients with acute massive pulmonary embolism in case of emergency surgical treatment.

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